中堅看護師の職業継続に関する文献検討 : 「離職」と「職業継続」の理由に焦点をあてて

目的：本研究は，日本における中堅看護師を対象にした先行文献から，中堅看護師の離職と職業継続に影響を与える要因を明らかにし，職業継続支援への示唆を得ることを目的とする．
方法：文献は，「医学中央雑誌Web(ver.5)」，「メディカルオンライン」，「CiNii」を使用し，「看護師and離職」，「中堅看護師and離職」，「中堅看護師and職業継続」，「中堅看護師and職務継続」というキーワードで検索をした．検索の範囲は，2005年から2017年までとした．対象文献は，「辞めたいと思った理由」と「働き続ける理由」について記載がある21文献で，「辞めたいと思った理由」と「働き続ける理由」を類似性に基づいて帰納的に分類し，カテゴリー化を行った．
結果：中堅看護師が「辞めたいと思った理由」として，【キャリアプランとの不一致】【やりがい不足】【人間関係によるストレス】【労働環境が悪い】【看護実践能力についての不安】【自己効力感の形成阻害】【特に働き続ける理由がない】のコアカテゴリーが抽出された．また，中堅看護師が「働き続ける理由」として，【キャリアプランとの一致】【やりがいがある】【良好な人間関係】【労働環境が良い】【看護実践能力についての自信】【自己効力感を高める体験】【特に辞める理由がない】【ストレス・マネージメント】のコアカテゴリーが抽出された．
考察：看護師が離職を考える要因には，キャリアプランや，仕事のやりがい，職場の人間関係，職場の労働環境，自身の看護実践能力と自己効力感が大きく関わっており，それらは共通して職務継続の要素にもなっていた．しかし，ストレス・マネージメントは，職業継続にだけみられる要因であり，効果的なストレス・マネージメントは，離職を思い留まらせることが示唆された．中堅看護師の職業継続には，ストレス・マネージメントに着目した支援が重要である．

Purposes: The aim of the present study was to clarify the factors that affect leaving and career continuation of mid-career nurses from prior literature and to obtain suggestions for vocational continuity support.
Method: A literature search of Japan Medical Abstracts Society, Medical Online, and CiNii Articles databases was conducted using the following keywords: “nurse and leaving,” “mid-career nurse and leaving,” “mid-career nurse and occupation continuation,” and “mid-career nurse and duties continuation,” including all studies published between 2005 and 2017. We investigated 21 studies that mentioned “the reason why mid-career nurses wanted to quit work” and “the reason why they continue working.” Further, we classified inductively “the reason why they wanted to quit work” and “the reason why they continue working” based on similarity and categorized them.
Result: “The reason why mid-career nurses wanted to quit work” was represented in seven categories, which included the following: [disagreement with the career plan], [lack of worth doing of work], [stress caused by human relations], [bad working environment], [uneasiness about nursing practice ability], [growth restraint of self-efficacy], and [there is no reason that continues working in particular]. In addition, “the reason why mid-career nurses continue working” was represented in the following seven categories: [agreement with the career plan], [with the worth doing], [good human relations], [good working environment], [experience to enhance self-efficacy], [there is not a reason to quit work in particular], and [stress management].
Conclusion: “Career plan,” “worth doing,” “human relations of the workplace,” “work environment,” “nursing practice ability,” and “self-efficacy” were related with the factor that nurses wanted to quit, including reasons for continuing occupation. However, stress management was a factor found in career continuity alone, and effective stress management was suggested as a factor that would change mid-carrier nurses’ feeling of wanting to quit work into wanting to continue work.